Search This Blog

Subscribe to this blog

Follow by Email

Fighting India’s silent epidemic

Tackling TB requires both strengthening the public sector and engaging the private sector

Over 60 per cent of all Indians seek health care in the private sector according to India’s last National Family Health Survey. This undoubtedly makes the private sector the largest provider of health services in India. The government health system, though vast and well-intentioned, continues to be overburdened with multiple challenges including long waiting hours, an ageing infrastructure, limited funding and human resources. Even though parallel providers of health services, the absence of partnerships between the public and private sector has disastrous implications for patients and for disease control. A striking case study is that of TB.

With 2.2 million new cases and close to 3,00,000 deaths each year, TB is India’s silent epidemic. The 60 per cent of all TB patients who first go to the private sector receive care whose quality varies enormously, often leading to delays in diagnosis and no assurance of cure. As a result, a large proportion of these patients move — sicker and poorer — from one provider to another, infecting others in the process.

Treatment access and reliability

While TB can affect anybody, studies have shown that it is four times more common in people in the lowest socio-economic quintile compared to the highest. A recent systematic review found that the total costs of TB for patients and affected families on average corresponded to more than half their yearly income. This makes it a clinical as well as an economic crisis.

How can India address this crisis? Tackling TB in India requires both strengthening the public sector and engaging the private sector. For a disease like TB, early diagnosis and correct treatment are the easiest ways to reduce transmission. India needs to give every patient, irrespective of whether they go to the public or private sector, access to quick and reliable diagnosis and treatment.

Studies have shown that TB is four times more common in people in the lowest socio-economic quintile compared to the highest

For the government, this means that every primary health centre (urban and rural) — the first point of care for the patient — should be capable of making a diagnosis of TB and initiating treatment.

For this, diagnostic facilities need to be upgraded and clinical and laboratory staff given training. Private services could be utilised for some of these investigations in PHCs where these facilities may not be available (for example imaging studies, paediatrician opinions and rapid molecular tests). Patients should not need to travel long distances to get a diagnosis.

Ultimately, the quality of health care provided and a “satisfied client” are the most successful advertisements for the health system. At the same time, we must actively engage the private sector in a mutually acceptable way — while patients continue to remain with the individual doctor, both diagnosis and treatment could be provided free through the public sector.

Brazilian example

Here, Brazil offers an excellent example, where TB drugs are offered only by the public health system and are unavailable in the private sector. TB drugs are bought through a centralised mechanism of acquisition and distribution, ensuring drug quality.

Such a model could easily work in India if combined with effective use of technology. Each patient diagnosed in the private sector could avail drugs through the use of a paper or electronic voucher valid at designated pharmacies. This would ensure that patients receive appropriate and quality-assured drug regimens reducing patient costs. Further, it would ensure notification of all patients and help in monitoring and follow-up to ensure cure.

There is obvious reluctance in the private sector to engage with the government because of the fear of losing their patients, excessive monitoring, delayed payments, etc. Hence, we must be flexible in our approach to treatment (as long as standards are followed) and create more transparency, accompanied by use of technology to address systemic delays.

Changes in TB programme

Rapid reduction in TB burden is not possible without significant changes in India’s TB programme. It requires uniform and equitable implementation of the diagnostic, treatment, public health and social support guidelines laid down in the Indian Standards of TB care, strengthening of human resources both at the Central and State level, using novel methods of monitoring patient compliance (e.g. mobile phone based) and launching a massive public awareness campaign. Procedures for procurement and distribution of drugs need to be streamlined to ensure a constant supply of quality-assured drugs. More flexibility in programme delivery needs to be given to State and district-level implementing officers. Alongside inputs to achieve universal health coverage, social protection interventions that address out-of-pocket expenses and the food and nutritional requirements of TB patients are also critical — an innovative example is the free breakfast scheme for TB patients launched by the Chennai Corporation.

India may take a cue from China, where TB prevalence declined by half as the government invested heavily in systemic improvements, modernisation and changing approaches to diagnosis and treatment. This revitalisation of TB services led to millions being able to access timely, high-quality TB treatment which considerably reducing the number of new TB cases.

India urgently needs similar investment in the health system combined with innovative strategies to address TB and drug resistant TB.

In 2013, the World Health Organization identified 3 million missing TB cases globally of which 1 million were in India. These 1 million missing cases fall somewhere between the public and the private sector and lack access to free care. If India wishes to end its TB crisis, we must begin by providing prompt diagnosis and treatment to our missing million. Yet this is unlikely to happen unless we transform our current TB programme while simultaneously engaging the vast private sector. If we do not act now, our inaction will make us responsible for continued suffering of patients and deaths.

(Soumya Swaminathan is director, National Institute for Research in Tuberculosis, Chennai, and Chapal Mehra is an independent New Delhi-based writer.)

Popular posts from this blog

As per the directives of the Honourable Supreme Court in its judgment dated,25.9.87, in writ petition No. 348-352 of 1985, all the State Governments, Medical Institutions and Universities are required to amend their rules and regulations to introduce a uniform residency scheme by 1993
“A uniform practice has to be evolved so that the discipline would be introduced. We accordingly allow the present arrangement to continue for a period of five yearsI.e. upto 1992 inclusive. For admission beginning from 1993 there would be only onepattern. All Universities and institutions shall take timely steps to bring about such amendments as may be necessary to bring statutes, regulations, and rules obtaining in their respective institutions in accord with this direction before the end of 1991 so that there may be no scope for raising of any dispute in regard to the matter.The uniform pattern has to be implemented for 1993. It is proper that one uniform system is brought into vogue throughout the co…

This research is being shared with us by a diligent reader on how deep the Media connections go. Puts the entire media bias in perspective. "1. Hindustan Times – Shobhna Bhartia, owner and editor-in-chief of Hindustan Times is a Congress MP from Rajya Sabha. 2. Vinod Sharma, HT Political Affairs editor, is essentially a Congress spokesman on all TV panel discussions, because once his boss’ term gets over, he will be looking out for her RS seat next 3. Barkha Dutt and Vir Sanghvi, famous Congress stooges (and intermediaries for UPA allies) who were exposed in the Radiagate scandal, and are virtual Congress spokespersons in their capacities as electronic media personalities, are the ones who write opinion and op-ed columns most frequently (once every week) on the editorial pages of HT. In return, Barkha and Sanghvi are rewarded with Padma Shris and other monetary compensation by the Nehru dynasty or Congress party. 4. NDTV’s promoters are Prannoy Roy and Radhika Roy. Radhika’s sister …

Here are the highlights of the survey: We received many votes in the survey, from various medical colleges of all states, ranging from batches 2000 to 2006.Received votes for more than seven PG Coaching Institutes from across the country including Bhatia, DAMS, IAMS, Speed PG Institute, MIMS Calicut, MEDPGTHRISSUR and others.Many students were in favour that rigorous self-study is important if NEET happens, and coaching is useful only with self-study.How the result is calculated?We have calculated the results by counting votes from only unique IPs to remove bias from multiple votes casting.An effective score is calculated institute-wise from the total votes submitted. This is to remove any bias occurred due to difference in number of votes for each institute.The effective scores are then compared under 4 broad ca…